Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis (SBP; sometimes called primary bacterial peritonitis) is an acute bacterial infection of ascitic fluid. There is often a history of cirrhosis and ascites. The clinical picture is highly variable as the patient may be asymptomatic. The course can be prolonged. The diagnosis is made by paracentesis and should be con - sidered in cirrhotic patients and those with ascites even when there is a low index of suspicion. The diagnosis is confirmed by 3 finding an increased neutrophil count of 250/mm in aspirated ascitic fluid. Culture of ascites is negative in as many as 60% of patients with clinical manifestations of SBP . When culture - is positive the most common pathogens include Gram-negative bacteria, usually Escherichia coli, and Gram-positive cocci (mainly streptococci and enterococci). Empirical treatment of SBP must be initiated immedi - ately after diagnosis and before the results of culture have been received. Although the choice of antibiotic may vary , a third-generation cephalosporin, e.g. cefotaxime, is a reason - ab le first-line treatment that avoids the renal toxicity of amino - glycosides. Alternatives are amoxicillin/clavulanic acid and quinolones such as ciprofloxacin. 1894–1963, physician, University of Pennsylvania, Philadelphia, PA,

(b) Axial

The incidence of pneumococcal peritonitis has declined greatly and the condition is now rare. It may complicate nephrotic syndrome or cirrhosis in children; however, otherwise healthy children may also be a ff ected. In girls, the route of infection may be via the vagina and Fallopian tubes, while a blood-borne route secondary to respiratory tract or middle-ear disease is also possible. The clinical onset is usually sudden, with pain usually local ised to the lower half of the abdomen. The temperature is raised to 39°C or more and there is usually frequent vomiting. After 24–48 hours, profuse diarrhoea is characteristic. There is usually increased frequency of micturition. The last two symp toms are caused by severe pelvic peritonitis. On examination, peritonism is usually di ff use but less prominent than in cases of a perforated viscus, leading to peritonitis. An underlying pathology must always be excluded before primary peritonitis can be diagnosed with certainty . Causative organisms include Haemophilus spp., group A streptococci and a few Gram-negative bacteria. Idiopathic streptococcal and staphylococcal peritonitis can also occur in adults. After starting antibiotic therapy and correcting dehydra tion and electrolyte imbalance, early surgery is required unless spontaneous infection of pre-existing ascites is strongly suspected, in which case a diagnostic peritoneal tap is useful. Laparotomy or laparoscopy ma y be used. Assuming that no other cause for the peritonitis is discovered, some of the exudate is aspirated and sent to the laboratory for microscopy , culture and sensitivity tests. Thorough peritoneal lavage is carried out and the incision closed. Antibiotics and fluid replacement therapy are continued and recovery is usual.